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Brian P Cervenka, Shyam Rao, D Gregory Farwell, Arnaud F Bewley
OBJECTIVE: Total laryngectomy is a well-established treatment for locally advanced laryngeal cancer. Evidence for the benefit of post-operative radiotherapy after laryngectomy in patients with locally advanced primaries and N0 or N1 nodal disease is limited. This study aims to determine whether total laryngectomy alone is adequate therapy for certain patient subgroups with locally advanced laryngeal cancer. DESIGN: We performed a retrospective survival analysis of patients in the surveillance epidemiology and end results (SEER) database with locally advanced laryngeal cancer between 2004-2012...
October 20, 2017: Clinical Otolaryngology
Theodore V Parran, A G Mace, Yael J Dahan, Christopher A Adelman, Mykola Kolganov
CONTEXT AND OBJECTIVE: Buprenorphine has been available with few reports of the dose range necessary to adequately maintain patients. We report on the effect of 8 mg/d versus 16 mg/d of buprenorphine on long-term patient retention in office-based opioid maintenance (OBOMT). DESIGN SETTING AND PARTICIPANTS: Case series, at an urban hospital-based primary care clinic providing OBOMT to 157 opiate-dependent, low socioeconomic status, uninsured, nonhomeless patients...
2017: Substance Abuse: Research and Treatment
Jasmine A Khubchandani, Connie Shen, Didem Ayturk, Catarina I Kiefe, Heena P Santry
BACKGROUND: As fewer surgeons take emergency general surgery call and hospitals decrease emergency services, a crisis in access looms in the United States. We examined national emergency general surgery capacity and county-level determinants of access to emergency general surgery care with special attention to disparities. METHODS: To identify potential emergency general surgery hospitals, we queried the database of the American Hospital Association for "acute care general hospital," with "surgical services," and "emergency department," and ≥1 "operating room...
October 16, 2017: Surgery
Michael T Schmeltz, Janet L Gamble
BACKGROUND: Many studies have found significant associations between high ambient temperatures and increases in heat-related morbidity and mortality. Several studies have demonstrated that increases in heat-related hospitalizations are elevated among individuals with diagnosed mental illnesses and/or behavioral disorders (MBD). However, there are a limited number of studies regarding risk factors associated with specific mental illnesses that contribute, at least in part, to heat-related illnesses (HRI) in the United States...
2017: PloS One
Olveen Carrasquillo, Michael Mueller
The Affordable Care Act (ACA) was the most significant expansion of health coverage since Medicare and Medicaid were enacted. The law resulted in approximately 13-20 million uninsured persons gaining coverage. Despite these gains, the ACA has numerous shortcomings. For progressives, the ACA was a unique opportunity to provide access to high-quality, comprehensive, equitable health coverage to all persons living in the United States. Using this perspective as our framework, in this review we highlight some of the limitations of the ACA and potential areas for refinement...
October 13, 2017: Annual Review of Medicine
Dana O Sarnak, David Squires, Greg Kuzmak, Shawn Bishop
Issue: Compared with other high-income countries, the United States spends the most per capita on prescription drugs. Goal: To compare drug spending levels and trends in the U.S. and nine other high-income countries — Australia, Canada, France, Germany, the Netherlands, Norway, Sweden, Switzerland, and the United Kingdom; consider potential explanations for higher U.S. spending; and explore patients’ exposure to pharmaceutical costs. Method: Analysis of health data from the Organisation for Economic Co-operation and Development, the 2016 Commonwealth Fund International Health Policy Survey, and other sources...
October 2017: Issue Brief of the Commonwealth Fund
David Xiao, Chaoyi Zheng, Manila Jindal, Lynt B Johnson, Thomas DeLeire, Nawar Shara, Waddah B Al-Refaie
BACKGROUND: The Affordable Care Act's (ACA) Medicaid expansion has been heavily debated due to skepticism of Medicaid's ability to provide high-quality care. Particularly, little is known whether Medicaid expansion improves access to surgical cancer care at high-quality hospitals. To address this question, we examined the effects of the 2001 New York Medicaid expansion, the largest in pre-ACA era, on this disparity measure. METHODS: We identified 67,685 nonelderly adults from the New York State Inpatient Database who underwent select cancer resections...
September 28, 2017: Journal of the American College of Surgeons
Chang Su, Kevin A Nguyen, Harrison X Bai, Dhikshitha Balaji, Ya Cao, Giorgos Karakousis, Paul J Zhang, Guiying Zhang, Rong Xiao
It remains controversial whether concurrent or subsequent chemoradiotherapy (CRT) provides additional survival benefits when compared to radiotherapy (RT) alone in localized extranodal natural killer/T-cell lymphoma (ENKTL), nasal type We identified 248 patients from the US National Cancer Data Base who were diagnosed with localized ENKTL from 2004-2014; 68.9% received CRT and 31.1% received RT alone. Over time, the use of CRT increased, while the use of RT alone decreased (p < .001). On multivariate analysis, CRT was associated with longer OS than RT alone (HR: 0...
October 5, 2017: Leukemia & Lymphoma
Jiang He, Vilma Irazola, Katherine T Mills, Rosana Poggio, Andrea Beratarrechea, Jacquelyn Dolan, Chung-Shiuan Chen, Luz Gibbons, Marie Krousel-Wood, Lydia A Bazzano, Analia Nejamis, Pablo Gulayin, Marilina Santero, Federico Augustovski, Jing Chen, Adolfo Rubinstein
Importance: Despite extensive knowledge of hypertension treatment, the prevalence of uncontrolled hypertension is high and increasing in low- and middle-income countries. Objective: To test whether a community health worker-led multicomponent intervention would improve blood pressure (BP) control among low-income patients with hypertension. Design, Setting, and Participants: A cluster randomized trial was conducted in 18 centers for primary health care within a national public system providing free medications and health care to uninsured patients in Argentina...
September 19, 2017: JAMA: the Journal of the American Medical Association
Seth A Berkowitz, Hilary K Seligman, Joseph Rigdon, James B Meigs, Sanjay Basu
Importance: Food insecurity is associated with high health care expenditures, but the effectiveness of food insecurity interventions on health care costs is unknown. Objective: To determine whether the Supplemental Nutrition Assistance Program (SNAP), which addresses food insecurity, can reduce health care expenditures. Design, Setting, and Participants: This is a retrospective cohort study of 4447 noninstitutionalized adults with income below 200% of the federal poverty threshold who participated in the 2011 National Health Interview Survey (NHIS) and the 2012-2013 Medical Expenditure Panel Survey (MEPS)...
September 25, 2017: JAMA Internal Medicine
Hannah F Xu, Robert S White, Dahniel L Sastow, Michael H Andreae, Licia K Gaber-Baylis, Zachary A Turnbull
STUDY OBJECTIVE: To confirm the relationship between primary payer status as a predictor of increased perioperative risks and post-operative outcomes after total hip replacements. DESIGN: Retrospective cohort study. SETTING: Administrative database study using 2007-2011 data from California, Florida, and New York from the State Inpatient Databases (SID), Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. PATIENTS: 295,572 patients age≥18years old who underwent total hip replacement with non-missing insurance data were collected, using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnoses and procedures code (ICD-9-CM code 81...
September 30, 2017: Journal of Clinical Anesthesia
Lu Shi, Chaoling Feng, Sarah Griffin, Joel E Williams, Lee A Crandall, Khoa Truong
Adverse selection predicts that individuals with lower health status would be more likely to sign up for health insurance. This hypothesis was tested among the long-term uninsured population in South Carolina (SC). This study used data from an in-person survey conducted from May 2014 to January 2015. Interviews were held with the long-term uninsured individuals at multiple sites throughout the state, using a multistage sampling method. SC residents aged 18 to 64 years who had had no health insurance for at least 24 consecutive months were eligible for the survey...
January 1, 2017: Inquiry: a Journal of Medical Care Organization, Provision and Financing
Ning Hsieh, Matt Ruther
Previous studies suggest that members of sexual minority groups have poorer access to health services than heterosexuals. However, few studies have examined how sexual orientation interacts with gender and race to affect health care experience. Moreover, little is known about the role in health care disparities played by economic strains such as unemployment and poverty, which may result from prejudice and discrimination based on sexual orientation. Using data for 2013-15 from the National Health Interview Survey, we found that most members of sexual minority groups no longer have higher uninsurance rates than heterosexuals, but many continue to experience poorer access to high-quality care...
October 1, 2017: Health Affairs
Alina S Schnake-Mahl, Benjamin D Sommers
There are 16.9 million Americans living in poverty in the suburbs-more than in cities or rural communities. Despite recent increases in suburban poverty, the perception of the suburbs as areas of uniform affluence remains, and there has been little research into health care barriers experienced by people living in these areas. The objectives of this study were to compare patterns of insurance coverage and health care access in suburban, urban, and rural areas using national survey data from 2005 to 2015 and to compare outcomes by geography before and after the Affordable Care Act took effect...
October 1, 2017: Health Affairs
Michel H Boudreaux, Rada K Dagher, Scott A Lorch
OBJECTIVE: To estimate whether the incidence of low birthweight and rates of infant mortality were associated with Massachusetts health reform in the overall population and for subgroups that are at higher risk for poor health outcomes. DATA SOURCES: Individual-level data on birthweight were obtained from the National Center for Health Statistics detailed natality files, and aggregated county-level mortality rates were generated from linked birth-death files. We used restricted versions of each file that had intact state and substate geographic identifiers...
October 2, 2017: Health Services Research
Narissa J Nonzee, Susie B Baldwin, Yan Cui, Rita Singhal
Trends in HPV vaccine awareness among parents of adolescent girls and boys (ages 13-17) and HPV vaccine uptake (≥1 dose) among girls (ages 13-17) were evaluated in Los Angeles County, California. Between 2007 and 2011, parental HPV vaccine awareness increased from 72% to 77% overall, with significant increases among mothers, Latinos, and respondents with daughters and Medi-Cal insured children. In 2011, parents who were male, older, less educated, Asian/Pacific Islander, and had sons remained significantly less likely to be aware...
September 26, 2017: Vaccine
Martin Cloutier, Mallik Greene, Annie Guerin, Maelys Touya, Eric Wu
BACKGROUND: The current societal costs of bipolar I disorder (BDI) have not been comprehensively characterized in the United States, as previous studies are based on data from two decades ago. METHODS: The costs of BDI were estimated for 2015 and comprised direct healthcare costs, non-healthcare costs, and indirect costs, calculated based on a BDI prevalence of 1%. The excess costs of BDI were estimated as the difference between the costs incurred by individuals with BDI and those incurred by individuals without BD or individuals from the general population...
September 14, 2017: Journal of Affective Disorders
Anthony L Asher, Clinton J Devin, Brandon McCutcheon, Silky Chotai, Kristin R Archer, Hui Nian, Frank E Harrell, Matthew McGirt, Praveen V Mummaneni, Christopher I Shaffrey, Kevin Foley, Steven D Glassman, Mohamad Bydon
OBJECTIVE In this analysis the authors compare the characteristics of smokers to nonsmokers using demographic, socioeconomic, and comorbidity variables. They also investigate which of these characteristics are most strongly associated with smoking status. Finally, the authors investigate whether the association between known patient risk factors and disability outcome is differentially modified by patient smoking status for those who have undergone surgery for lumbar degeneration. METHODS A total of 7547 patients undergoing degenerative lumbar surgery were entered into a prospective multicenter registry (Quality Outcomes Database [QOD])...
September 29, 2017: Journal of Neurosurgery. Spine
Sapna Desai, Ajay Mahal, Tara Sinha, Joanna Schellenberg, Simon Cousens
BACKGROUND: A community-based health insurance scheme operated by the Self-Employed Women's Association in Gujarat, India reported that the leading reasons for inpatient hospitalisation claims by its members were diarrhoea, fever and hysterectomy - the latter at the average age of 37. This claims pattern raised concern regarding potentially unnecessary hospitalisation amongst low-income women. METHODS: A cluster randomised trial and mixed methods process evaluation were designed to evaluate whether and how a community health worker-led education intervention amongst insured and uninsured adult women could reduce insurance claims, as well as hospitalisation and morbidity, related to diarrhoea, fever and hysterectomy...
December 2017: Journal of Global Health
Seth Freedman, Sayeh Nikpay, Aaron Carroll, Kosali Simon
CONTEXT: The Affordable Care Act resulted in unprecedented reductions in the uninsured population through subsidized private insurance and an expansion of Medicaid. Early estimates from the beginning of 2014 showed that the Medicaid expansion decreased uninsured discharges and increased Medicaid discharges with no change in total discharges. OBJECTIVE: To provide new estimates of the effect of the ACA on discharges for specific conditions. DESIGN, SETTING, AND PARTICIPANTS: We compared outcomes between states that did and did not expand Medicaid using state-level all-capture discharge data from 2009-2014 for 42 states from the Healthcare Costs and Utilization Project's FastStats database; for a subset of states we used data through 2015...
2017: PloS One
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